|
HIV/AIDS in Bangladesh: Current situation
Prevalence information and surveillance data:
Bangladesh with its 127 million population is still fortunate to
be a low prevalent country for HIV/AIDS as revealed in three
consecutive sentinel surveillances, although geographically the
country is located in continuity with two very high prevalent
nations. The first HIV positive case in this country was
detected in 1989 and according to government sources, till date,
a total of 157 HIV positive cases have been reported in which
the male population predominates. From available information, so
far, 17 HIV infected persons developed AIDS of which 11 already
died. In reality, HIV/AIDS epidemic in Bangladesh is not very
well understood and the existing situation is only partly known.
Although it is not known exactly how many people are infected,
it is true that HIV is being detected among our population
especially among vulnerable cohorts. The first National Sentinel
Surveillance (1998-1999) revealed an overall HIV prevalence
among the high-risk behaviour practicing sample population to be
0.4% and in second survey (1999 – 2000) it was 0.2%. However,
the sample size of the two surveys were different and new
categories of high-risk population were included as sample in
the second survey. The first survey revealed that the rate of
seropositivity in brothel population was six per 1000 sex
workers. Among injecting drug users (IDUs), the rate was 25 per
1000 population. The study also found that 13% of the street
based female sex workers had injected themselves with drugs,
although none of those had been tested positive for HIV. No HIV
was found in a sample of truckers. Some people coming to
government STD clinics in some parts of the country also had
HIV, about three per 1000 population. Among men who have sex
with men (MSM), HIV seropositivity was found at a rate of about
2 per 1000 people. Epidemiologically, the findings of the
second sentinel survey did not have a significant difference but
it did increase the reliability of the previous findings.
Findings of the third surveillance (2000 – 2001) have just been
made available. Surveillance findings nevertheless concluded
that high level of behavioural risk factors for the acquisition
of HIV infection are very much in existence at least among the
sampled population. It is specifically clear from the
surveillance that some groups of people who practice high-risk
sexual behaviour have a large number of sexual partners,
averaging between 12 and 40 per year. Each sex worker, of
course, has many more, around 1000 per year.
KABP survey findings:
When the sentinel surveillances showed the above figures, a
number of studies and KABP surveys showed a very low knowledge
on HIV/AIDS among different population groups. According to a
study done in 1999, only 11.59% of surveyed population could
mention AIDS as a sexually transmitted disease and 54%
respondents have mentioned that having sex with HIV positive
person can spread AIDS. Another KABP survey conducted on
potential and returnee migrant workers revealed that 61% have
heard of AIDS, only 4% of them have the full knowledge on the
modes of transmission, 43% have partial knowledge and the rest
53% have either misconception or no knowledge on the modes of
transmission of HIV/AIDS.
STD
prevalence:
In
spite of the low prevalence of HIV in the country, many factors
suggest that HIV may spread rapidly in the near future. For
example, studies have shown high rates of STDs in various
populations. In 1989, syphilis rates of 56% and 39% were found
among floating and institutional SWs respectively. In 1997, 54%
of 980 SWs gave a history of present or past symptomatic STDs.
Recent reports indicate high levels of STDs amongst various
other groups. As in many other Asian countries, condoms are not
generally the preferred method of contraception. Furthermore,
knowledge of condoms as a means to prevent STDs is very low.
Existing high-risk behavioural practice:
Moreover, sex outside marriage might be more widespread than
traditionally acknowledged. Documented sexual practices include
premarital, extramarital and male-to-male sex particularly among
youth. For example, some studies indicated a high percentage of
youths to have experience of sex before marriage and occurrences
of induced abortions among women. Sixty percent of long distance
truck drivers have sex with commercial sex workers about twice a
month without any knowledge of HIV/AIDS. Extra-marital sex
appears to exist even in rural societies and in particular where
husbands are absent for long periods. Important studies of the
sex industry identified large numbers (100,000) of generally
non-literate SWs whose customers represent all segments of
society. Female SWs have an average of 2-5 clients a day, making
the number of clients about half a million men a day.
Migration issues:
Bangladesh has large number of international and national
migrant labourers, transport workers and uniformed personnel.
These individuals spend extensive periods away from their
families that contribute to getting involved in new and
different types of sexual relationships. Transborder mobility is
high. Bangladesh also hosts large communities of expatriate
refugees while itself having nationals with refugee status in
bordering countries.
Injecting drug users:
Available data from Client Monitoring System of Department of
Narcotics Control and other research reports shows that
prevalence of injecting drug use (IDU) is on the rise. Most
injecting drug users (IDUs) in Bangladesh share needles. In some
areas the professional injectors use one needle for many IDUs.
There are estimated 25,000 IDUs mainly in Dhaka, Rajshahi, and
other towns including border areas. Prevalence of STDs is quite
high among drug users in general. A considerable proportion of
IDUs are clients of sex workers and many IDUs are married,
putting their family members at a higher risk of disease
transmission. As mentioned earlier, the First National
Surveillance for HIV and syphilis among the population
practicing high-risk behaviour showed highest seropositivity for
HIV among IDUs that was 2.5%. Second surveillance has shown
almost the similar trend.
Blood transfusion services:
The
existing blood transfusion system is not yet without risk of HIV
transmission and improvement in the existing facilities is
underway. Problems include approximately 200,000 required units
of blood is currently largely (70-75%) provided by professional
blood donors of whom approximately 20% are positive for
hepatitis B and/or syphilis. In addition to providing safe
(screened) blood, the added risk of transmission caused by
medical/surgical/dental procedures needs to be considered in the
light of under-practiced universal safety precautions.
Vulnerability of women:
Very little attention has so far been paid to the issue of
mother to child transmission of HIV at any level. An effective
awareness generation for all women, provision for counseling for
pregnant women or those contemplating pregnancy, and breast
feeding mothers, HIV testing facilities for consenting mothers,
training of health personnel related to pregnancy and child
birth, and research on cost-effectiveness of anti-retroviral
therapy are almost nonexistent.
Contextual features:
Bangladesh has many special contextual features that are
relevant to HIV infection. These include widespread poverty,
unequal access to health services, often-subordinate status of
women, and low literacy and education levels. All combine to
restricting knowledge in relation to health and negotiating
power in matters of sex. A multi-sectoral response, and policy
level support and commitment for empowerment of vulnerable
groups to address the issues like stigma and discrimination are
yet to be properly visualized.
Research: Research, especially operational research, in the
field of HIV and AIDS is very limited in this country.
Operational research is an essential component of effective
implementation of any programme particularly those related to
preventive actions and other cross cutting issues.
Possibility of an epidemic:
The
above mentioned factors indicate that the present HIV situation
could evolve rapidly into an impending and escalating epidemic
in this country with serious health and socio-economic
consequences. The epidemic of AIDS could bring, in future, needs
for major adjustments for individuals and their families, the
health system, and within the community and society as a whole.
An overburdened health care system both in terms of human and
financial resources, disintegration of family structures,
problems relating to increased poverty, numbers of orphans and
abandoned children, and shortage of manpower in agriculture,
industry and other sectors can be apprehended.
As
of middle of this year, levels of HIV were low and appeared to
have been increased quite slowly over the past few years. At
this moment it is not possible to predict how much more it would
increase and how rapid such an increase would take place. Only
continuous and repeated surveillance will be able to provide us
the right kind of information. From the information so far
available, it may be assumed that Bangladesh is in the
pre-epidemic stage for HIV (i.e. HIV prevalence did not exceed
1% among the sex workers and HIV has not disseminated to the
general population). If an epidemic errupts, it will errupt
first among the population of low-fee sex workers with the
highest average turnover of customers. The sex workers with the
highest partner turnover are low-fee brothel based SWs. HIV will
be introduced into these high volume sex network primarily by
male foreign transport workers, traders or seafarers from nearby
countries who regularly frequent towns and ports along the
Bangladesh border; and/or by male Bangladeshi transport workers,
traders or seafarers who have commercial sex encounters in high
prevalence areas of nearby countries and regularly return to
Bangladesh.
It
may thus be said that even though the spread of HIV infection in
this country has been slow, its continuous detection, even
though at a low level, call for an immediate action. We cannot
miss this window of opportunities for a preventive action and
let the epidemic to scale up. Rather, there is very little scope
for complacence and there are only very strong reasons for
concern.
Prevention and intervention initiatives:
Fortunately, Bangladesh has been appreciably prompt for a timely
response to prevent the epidemic. This is manifested, among
others, by adopting a national policy, developing a long-term
strategy, initiating multi-sectoral programme implementation,
increasing partnership with NGOs and other community
organizations, developing regular surveillance system,
prioritizing targeted intervention, ensuring participation of
PLWHA in preventive action, initiating safe blood transfusion
efforts, attracting donor support and resource mobilization, and
making some major breakthrough in the field of information
dissemination. |
SDNP
HOME